Figure 4B. Final repair of a duodenal perforation with an omental patch.
A patch of omentum is then brought without tension and positioned over the perforation, and
the sutures are successively tied to secure the omentum onto the defect itself (Figure 4B).
In cases of “giant” perforation, where the defect measures 2.5 cm or more, partial gastrectomy
with closure of the duodenal stump should be considered [23]. Alternatively, in situations
where the clinical situation or expertise dictates more expeditious surgery, the duodenal
perforation should be closed as well as possible around a large Foley or T‐tube catheter to
create a controlled fistula [23]. Other methods described include a free omental and jejunal
serosal “plug” [23].
7.2. Inserted foreign objects and anorectal objects
It is essential to remove all retained anorectal foreign bodies [8]. However, extraction of rectal
foreign bodies may be challenging. The medical literature confirms the diversity of the
problem, and equally some ingenious solutions [19, 29–40]. Techniques described range from
simple digital extraction to complicated surgical removal. Several algorithms for management
have also been proposed [6, 7, 29], with a tendency to progress from least to most invasive as
required [7]. This approach will result in the best chance of success with the lowest risk to the
patient [7].
Unless signs of peritonitis are present, or the patient is unstable, both of which necessitate
emergency laparotomy, an initial attempt at bedside extraction is advised [15]. Bedside
extraction is successful in 60–75% of cases [7]. A variety of tools can be used as adjunct retrieval
devices including obstetric forceps, ring forceps, Kocher clamps, suction devices and various
grasping forceps. The instruments used vary according to the characteristics of each case. For
example, in cases where the rectal foreign body has created a seal with the rectal mucosa [15],
a balloon catheter such as a Foley may be used to pull the foreign body distally along the GIT
[41–44]. The Foley is inserted, deflated and passed proximally to the retained object, then
inflated and subsequently pulled to drag the foreign body along the bowel. This technique is
useful in cases in which the rectal lumen is obstructed by a smooth foreign body. The foreign
Gastrointestinal Foreign Bodies
http://dx.doi.org/10.5772/6346485